Schizophrenia
Conditions
Keywords
Schizophrenia, Cognitive Adaptation Training, Forensic, Inpatient, Cognition, Environmental Supports
Brief summary
The proposed project will be a mixed-methods feasibility study of modified Cognitive Adaptation Training for an inpatient forensic mental health population (finCAT). Cognitive Adaptation Training (CAT) is an evidence-based compensatory cognitive intervention that focuses on improving functioning through the provision of environmental supports and cues. CAT is typically applied in outpatient care but has been successfully modified for inpatient service contexts in a Netherlands trial and at CAMH in previous pilots for both forensic and non-forensic inpatient populations.
Detailed description
The proposed project will expand the investigators knowledge of the role of compensatory cognitive interventions for forensic inpatient populations with schizophrenia. Over the course of 6 months, the investigators will conduct a feasibility study of the delivery of a modified forensic inpatient version of Cognitive Adaptation Training. The objective of this single group study with pre-post and follow up assessments is to determine if preliminary outcomes and follow up findings support the feasibility of a modified version CAT within a forensic inpatient setting. Feasibility data will be used to inform (i) any necessary adjustments to the intervention, (ii) any necessary adjustments to the optimal time of study for outcomes to be observed, and (iii) to inform future trials with respect to anticipated recruitment and drop-out rates and optimal powering. This study would be among the few examinations of CAT as an inpatient intervention to date, as well as the first to examine a modified cognitive adaptation training approach in both a North American and forensic inpatient setting, and would make a substantial contribution to the evidence-based intervention literature. This intervention will be referred to as forensic inpatient CAT or finCAT. The questions for this project are: 1. Is finCAT feasible for forensic inpatient populations with a schizophrenia spectrum diagnosis? Based on preliminary work the investigators hypothesize that finCAT will prove acceptable to patients and inpatient staff and will demonstrate positive outcomes with respect to functioning and inpatient room organization. 2. What are the attitudes of inpatient forensic occupational therapists and clinical teams towards implementing finCAT on their units? This study will expand on the preliminary work of the investigators at CAMH. The study will be implemented on four CAMH general security forensic inpatient units. There will be four weeks of CAT Clinician--delivered treatment focusing on two goal areas - room organization and personal hygiene, followed by two months of maintenance by CAT Unit Champions with pre, post, and two-month follow-up, as well as project-end evaluations. In the first four weeks, the investigators will conduct a trial of finCAT for two of the four inpatient general forensic units, followed by two months of finCAT maintenance with Unit CAT Champions supported by the CAT Clinician. This process would then be repeated on the remaining two general units at CAMH. Previous implementation of CAT has demonstrated gains within one-month; however, follow-up assessments were not conducted to determine if gains were maintained over time. While brief, this time period (i) reflects the intent of this study as a pilot test of feasibility and, (ii) aligns with this circumscribed version of CAT (as compared to the more comprehensive community version with broader outcome domains). Data will be collected from both primary participants (inpatients) and the clinical team.
Interventions
OTHERCognitive Adaptation Training (CAT)
Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.
Sponsors
Centre for Addiction and Mental Health
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. A chart diagnosis of a schizophrenia spectrum illness. 2. Capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant. 3. Participant residing on a CAMH inpatient forensic unit (general security)
Exclusion criteria
1. High paranoia 2. Primary issue of hoarding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Goal Attainment Scaling (GAS) - Goal 2 | Baseline | Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager. |
| Clutter Image Rating Scale (CIRS) - Patient-rated | Baseline | Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken. |
| Life Skills Profile (LSP) - Self-Care Subscale | Baseline | Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, & Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention. |
| Life Skills Profile (LSP) - Self-care Subscale | 4-Weeks Post-Intervention | Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, & Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention. |
| Goal Attainment Scaling (GAS) - Goal 1 | Baseline | Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager. |
| Clutter Image Rating Scale (CIRS) - Blind-rated | Baseline | Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Essen Climate Evaluation Schema (Essen CES) | Baseline | The therapeutic alliance on the unit will be measured by clinician and client ratings on the Essen Climate Evaluation Schema (Essen CES; Schalast et al., 2008). The Essen CES is a 15-item questionnaire measured on a 5-point Likert scale ranging from 'Not at all' to 'Very Much' and consists of three subscales: (1) Patient's Cohesion, (2) Experienced Safety, and (3) Therapeutic Hold. For this study, client and clinician ratings on the Therapeutic Hold and Experienced safety subscales will be collected. For each sub-scale, the max is 20 and minimum is 0. Higher scores indicate greater experienced safety and therapeutic hold. |
| Qualitative Care Provider Attitudes | 2 months after month of service implementation | The attitudes of the team members towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT, and perceptions of team tension or conflict arising or abating during the implementation of finCAT. Small focus groups with healthcare providers will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim. |
| Qualitative Participant Attitudes | 2 months after month of service implementation | The attitudes of the participants towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT. Individual interviews with interested clients will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim. |
| Evidence-Based Practice Attitude Scale (EBPAS) | Baseline | The attitudes of the team members towards finCAT will be measured using the Evidence-Based Practice Attitude Scale (EPBAS; Aarons, 2004) adapted to specifically target attitudes towards CAT. The EPBAS is a self-report questionnaire consisting of 36 items measured on a 5-point Likert scale ranging from 0 ('Not at all') to 4 ('To a very great extent') and consists of 12 subscales. Maximum is 4. Minimum is 0. Higher scores indicate a more open attitude towards new types of therapy, interventions or treatments including manualized therapy. |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Inpatient Clients Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security)
Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies. | 18 |
| Total | 18 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | Inpatient Clients |
|---|---|
| Age, Continuous | 38.1 years STANDARD_DEVIATION 10.6 |
| Approximate Age of First Episode | 21.3 years STANDARD_DEVIATION 7.7 |
| Approximate Length of Illness (Years) | 16.8 years STANDARD_DEVIATION 10.5 |
| Concurrent Diagnosis No | 2 Participants |
| Concurrent Diagnosis Yes | 16 Participants |
| Dual Diagnosis ADHD and Intellectual Disability | 1 Participants |
| Dual Diagnosis Attention Deficit Hyperactivity Disorder | 2 Participants |
| Dual Diagnosis Intellectual Disability | 2 Participants |
| Dual Diagnosis None | 13 Participants |
| Education College Diploma | 2 Participants |
| Education High School | 5 Participants |
| Education Less than High School | 2 Participants |
| Education Some College | 2 Participants |
| Education Some High School | 5 Participants |
| Education Some University | 1 Participants |
| Education Undergraduate Degree | 1 Participants |
| Length of Stay (NCR Data-Treatment Start Date) | 2770.4 days STANDARD_DEVIATION 2118.8 |
| Not Criminally Responsible/Unfit to Stand Trial Status NCR | 18 Participants |
| Not Criminally Responsible/Unfit to Stand Trial Status UST | 0 Participants |
| Primary Diagnosis Schizoaffective Bipolar | 3 Participants |
| Primary Diagnosis Schizoaffective Disorder | 2 Participants |
| Primary Diagnosis Schizophrenia | 13 Participants |
| Race/Ethnicity, Customized Black | 12 Participants |
| Race/Ethnicity, Customized Caucasian | 6 Participants |
| Secondary Diagnosis Alcohol Dependence | 5 Participants |
| Secondary Diagnosis Antisocial Personality Disorder | 4 Participants |
| Secondary Diagnosis Borderline Intelligence | 1 Participants |
| Secondary Diagnosis Cannabis Use | 5 Participants |
| Secondary Diagnosis None | 1 Participants |
| Secondary Diagnosis Paraphilia Not Otherwise Specified | 1 Participants |
| Secondary Diagnosis Substance Abuse | 1 Participants |
| Secondary Diagnosis Substance Use | 4 Participants |
| Sex: Female, Male Female | 1 Participants |
| Sex: Female, Male Male | 17 Participants |
| Violent Offense No | 3 Participants |
| Violent Offense Yes | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 18 |
| other Total, other adverse events | 0 / 18 |
| serious Total, serious adverse events | 0 / 18 |
Outcome results
Primary
Clutter Image Rating Scale (CIRS) - Blind-rated
Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Clutter Image Rating Scale (CIRS) - Blind-rated | 2.28 score on a scale | Standard Deviation 0.575 |
Primary
Clutter Image Rating Scale (CIRS) - Blind-rated
Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.
Time frame: 4-Weeks Post-Intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Clutter Image Rating Scale (CIRS) - Blind-rated | 1.56 score on a scale | Standard Deviation 0.616 |
Primary
Clutter Image Rating Scale (CIRS) - Blind-rated
Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.
Time frame: 2-Month Follow-Up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Clutter Image Rating Scale (CIRS) - Blind-rated | 1.44 score on a scale | Standard Deviation 0.511 |
Primary
Clutter Image Rating Scale (CIRS) - Patient-rated
Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.
Time frame: 4-Weeks Post-Intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Clutter Image Rating Scale (CIRS) - Patient-rated | 1.56 score on a scale | Standard Deviation 0.71 |
Primary
Clutter Image Rating Scale (CIRS) - Patient-rated
Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Clutter Image Rating Scale (CIRS) - Patient-rated | 1.94 score on a scale | Standard Deviation 0.8 |
Primary
Goal Attainment Scaling (GAS) - Goal 1
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: 2-Month Follow-Up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 1 | 0.81 score on a scale | Standard Deviation 0.889 |
Primary
Goal Attainment Scaling (GAS) - Goal 1
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 1 | -1.00 score on a scale | Standard Deviation 0 |
Primary
Goal Attainment Scaling (GAS) - Goal 1
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: 4-Week Post-Intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 1 | 1.06 score on a scale | Standard Deviation 0.984 |
Primary
Goal Attainment Scaling (GAS) - Goal 2
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 2 | -1.00 score on a scale | Standard Deviation 0 |
Primary
Goal Attainment Scaling (GAS) - Goal 2
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: 2-Month Follow-Up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 2 | 0.78 score on a scale | Standard Deviation 0.878 |
Primary
Goal Attainment Scaling (GAS) - Goal 2
Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.
Time frame: 4-Week Post-Intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Goal Attainment Scaling (GAS) - Goal 2 | 1.11 score on a scale | Standard Deviation 1.13 |
Primary
Life Skills Profile (LSP) - Self-care Subscale
Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, & Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention.
Time frame: 2-Month Follow-Up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Life Skills Profile (LSP) - Self-care Subscale | 24.61 score on a scale | Standard Deviation 4.79 |
Primary
Life Skills Profile (LSP) - Self-care Subscale
Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, & Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention.
Time frame: 4-Weeks Post-Intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Life Skills Profile (LSP) - Self-care Subscale | 24.00 score on a scale | Standard Deviation 5.64 |
Primary
Life Skills Profile (LSP) - Self-Care Subscale
Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, & Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Life Skills Profile (LSP) - Self-Care Subscale | 23.56 score on a scale | Standard Deviation 5.52 |
Secondary
Essen Climate Evaluation Schema (Essen CES)
The therapeutic alliance on the unit will be measured by clinician and client ratings on the Essen Climate Evaluation Schema (Essen CES; Schalast et al., 2008). The Essen CES is a 15-item questionnaire measured on a 5-point Likert scale ranging from 'Not at all' to 'Very Much' and consists of three subscales: (1) Patient's Cohesion, (2) Experienced Safety, and (3) Therapeutic Hold. For this study, client and clinician ratings on the Therapeutic Hold and Experienced safety subscales will be collected. For each sub-scale, the max is 20 and minimum is 0. Higher scores indicate greater experienced safety and therapeutic hold.
Time frame: 2-Month Follow-Up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Inpatient Clients | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 13.15 score on a scale | Standard Deviation 3.56 |
| Inpatient Clients | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 12.77 score on a scale | Standard Deviation 4.68 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 11.06 score on a scale | Standard Deviation 3.17 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 15.25 score on a scale | Standard Deviation 2.89 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 12.17 score on a scale | Standard Deviation 2.48 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 15.83 score on a scale | Standard Deviation 1.17 |
Secondary
Essen Climate Evaluation Schema (Essen CES)
The therapeutic alliance on the unit will be measured by clinician and client ratings on the Essen Climate Evaluation Schema (Essen CES; Schalast et al., 2008). The Essen CES is a 15-item questionnaire measured on a 5-point Likert scale ranging from 'Not at all' to 'Very Much' and consists of three subscales: (1) Patient's Cohesion, (2) Experienced Safety, and (3) Therapeutic Hold. For this study, client and clinician ratings on the Therapeutic Hold and Experienced safety subscales will be collected. For each sub-scale, the max is 20 and minimum is 0. Higher scores indicate greater experienced safety and therapeutic hold.
Time frame: Baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Inpatient Clients | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 13.46 score on a scale | Standard Deviation 3.6 |
| Inpatient Clients | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 12.85 score on a scale | Standard Deviation 4.36 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 10.94 score on a scale | Standard Deviation 3.28 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 15.19 score on a scale | Standard Deviation 3.39 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Experienced Safety | 10.67 score on a scale | Standard Deviation 4.55 |
| Nurses | Essen Climate Evaluation Schema (Essen CES) | Therapeutic Hold | 14.67 score on a scale | Standard Deviation 2.94 |
Secondary
Evidence-Based Practice Attitude Scale (EBPAS)
The attitudes of the team members towards finCAT will be measured using the Evidence-Based Practice Attitude Scale (EPBAS; Aarons, 2004) adapted to specifically target attitudes towards CAT. The EPBAS is a self-report questionnaire consisting of 36 items measured on a 5-point Likert scale ranging from 0 ('Not at all') to 4 ('To a very great extent') and consists of 12 subscales. Maximum is 4. Minimum is 0. Higher scores indicate a more open attitude towards new types of therapy, interventions or treatments including manualized therapy.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Evidence-Based Practice Attitude Scale (EBPAS) | 3.15 score on a scale | Standard Deviation 0.35 |
| Nurses | Evidence-Based Practice Attitude Scale (EBPAS) | 2.83 score on a scale | Standard Deviation 0.7 |
Secondary
Evidence-Based Practice Attitude Scale (EBPAS)
The attitudes of the team members towards finCAT will be measured using the Evidence-Based Practice Attitude Scale (EPBAS; Aarons, 2004) adapted to specifically target attitudes towards CAT. The EPBAS is a self-report questionnaire consisting of 36 items measured on a 5-point Likert scale ranging from 0 ('Not at all') to 4 ('To a very great extent') and consists of 12 subscales. Maximum is 4. Minimum is 0. Higher scores indicate a more open attitude towards new types of therapy, interventions or treatments including manualized therapy.
Time frame: 2-Month Follow-Up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Inpatient Clients | Evidence-Based Practice Attitude Scale (EBPAS) | 3.22 score on a scale | Standard Deviation 0.24 |
| Nurses | Evidence-Based Practice Attitude Scale (EBPAS) | 2.92 score on a scale | Standard Deviation 0.55 |
Secondary
Qualitative Care Provider Attitudes
The attitudes of the team members towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT, and perceptions of team tension or conflict arising or abating during the implementation of finCAT. Small focus groups with healthcare providers will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim.
Time frame: 2 months after month of service implementation
Secondary
Qualitative Participant Attitudes
The attitudes of the participants towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT. Individual interviews with interested clients will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim.
Time frame: 2 months after month of service implementation